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. . __1- <br /> APPLICATION FOR SANITATION PERMIT Permit No -�------- <br /> Date Issued <br /> Y A � (Complete in Duplicate) <br /> 1 <br /> on is h'eareby'made to the San Joaquin Local Health District for a permit to construct and install the work herein described, <br /> gThis application is made in compliant wi#h Coun#y rdinance No. <br /> 549. <br /> ---------------- <br /> JOB ADDRESS LOCATI .a •� .. <br /> Owner's Name_ _ - b F Phone. " <br /> --- ----------- <br /> Address--(5--- ------ -----------"---•--------------------------------------------------------------------------------------------- <br /> Contractor's Name.. _ i --------- - --- - ----------------------- --------------------------- Phone----------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel�❑ Other ❑ �r <br /> F Number of living units: __. __FNumber of bedrooms ._± Number baths ---�__ Lot size _�-0-0---x---�--f1ar-�----------------- <br /> Water SuPPIY Publicsystem ❑ Community system ElPrivate Depth to Water Table -------- ft. <br /> { Character of soil to a depth of 3 feet: Sand • Gravel ❑ Sandy Loam r Clay Loam ❑ Clay [I AdobeHardpan ❑ 't <br /> i� <br /> P eV, plication Made: Yes E] No E?F New Construction: Yes No ❑ <br /> TYPE F INSTALLATION AND SPECIFICATIONS: ._. <br /> ¢ (No septic tank or cesspool permitted if Public sewer is available within 200 f/Ieettj.) p <br /> Dista cP fro fou on-_l--f!_---------.Mate ill----------- --------- <br /> a <br /> ------------•-- ---------- --• <br /> Septic ank: Distance from nearest wellf/_ -- y f <br /> No. of compartments---------- Size _X ��� Lid deptjh Capacity <br /> -Distance from foundation---Z-A.----.Distance to nearesf lot lin 4r--05. <br /> 1W_ <br /> Dispos Field: Distance from nearest w i -0__ _ Length of each line--------I_1_0 Width of french--_---- - --#------------ <br /> Number of line"s__.._____ _ L 97 <br /> Type of filter materi ' - -Depth of filter material---.:-LiF---- -Total length---------- --- -- ------ ------ r <br /> Seepage Pit: Distance to nearest well__--------------------Distance from foundation----------------._Distance to nea—re3tdot line----------------- <br /> Number <br /> ------ ---_-Number of pits----------------------Lining material----------------------Size: Diameter---------------------•-.Depth--------------------------------- <br /> Y � <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-- ._--.-.------Lining material------------------------------- <br /> Size: Diameter-------------------- <br /> ❑ --------- <br /> --------Depth--------------------- ------------------------------Liquid Capacity-----------------------------gals. <br /> - <br /> Privy: Distance from nearest well-----__-------------- ____-----.______._----Distance from nearest building-----._._.._______._.______.____--_-_-__- <br /> ❑ Distance to nearest lot line------------------- --------------------------------------------------- ---------------------------- ------------------------------------------ " <br /> Remodeling and/or repairing (describe):---------------------------------------I -- ----------------•---------------•--•--------- <br /> ------------------ <br /> ----------------------------•---------------------------_-------------­---------- --------------- <br /> I <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances,Atate laws, d rules and regulations of the San Joaquin Local Health District. <br /> ------------ ------(Owner and/or Contractod(Signed) ---------------------------=------- <br /> (------------------------------------------------------------------------------------------ Title <br /> - - -- - - -- - - - <br /> ----- --- ----- -- --------- ----------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B111 -------- <br /> _ -------- -------- --------------------------------------------------------------------------- <br /> DAT - --- ------------------------------------------------------ <br /> - <br /> REVIEWED BY----------------------------------- ---- - --------------------------------------------------------- DATE <br /> �. <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------ ------ DATE-------- - ---------------------------------- <br /> Alterations and/or recommendations-------- -------- ---------- ---------------------- ---------------------------------------- <br /> i --------------------------------------------•--------------------- <br /> -------------------- - <br /> 1 ---------------------------------------------------------`--------- <br /> -- <br /> FINAL INSPECTION BY:--------- - � - <br /> // --------------------------------- -------- <br /> i <br /> SAN JOAQUIN LOCAL HEALTH-DISTRICT <br /> 130 South American Street 1 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, Caiifornia Lodi, California Manteca, California Tracy, Caiifornia <br /> ES-4-2M 8-51 Revised W-2100 <br />